| Aunt Martha's Youth Service Center, Inc | |
|
1515 Lake St Hanover Park IL 60133-4896 | |
| (708) 747-7100 | |
| Not Available |
| Full Name | Aunt Martha's Youth Service Center, Inc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1515 Lake St, Hanover Park, Illinois |
| Authorized Official Name and Position | Christopher J Nordloh (CFO) |
| Authorized Official Contact | 7087477100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Aunt Martha's Youth Service Center, Inc 19990 Governors Hwy Olympia Fields IL 60461-1021 Ph: (708) 747-7100 | Aunt Martha's Youth Service Center, Inc 1515 Lake St Hanover Park IL 60133-4896 Ph: (708) 747-7100 |
| NPI Number | 1407014046 |
|---|---|
| Provider Enumeration Date | 05/30/2008 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407014046 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 049 (Illinois) | Primary |
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